Abstract
Bariatric surgery has helped patients attain not only significant and sustained weight loss but has also proved to be an effective means of mitigating or reversing various obesity-related comorbidities. The impressive rates of remission or resolution of type 2 diabetes mellitus (T2D) following bariatric surgery are well documented and have rightly received great attention. Less understood are the effects of bariatric surgery on cardiovascular disease (CVD) and its underlying risk factors. Thanks to the availability of increasingly sensitive laboratory tools, the emerging science of lipidomics and metagenomics is poised to offer significant contributions to our understanding of metabolically induced vascular diseases. They are set to identify novel mechanisms explaining how the varied approaches of bariatric surgery produce the remarkable improvements in multiple organs observed during patient follow-up. This article reviews recent and novel findings in patients through the lens of lipidomics with an emphasis on CVD.
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Abbreviations
- BMI:
-
Body mass index
- BPD:
-
Biliopancreatic diversion
- (hs)-CRP:
-
(High-sensitive)-C-reactive protein
- CVD:
-
Cardiovascular disease
- FAs:
-
Fatty acids
- FFA:
-
Free fatty acids
- FRS:
-
Framingham risk score
- HbA1C :
-
Glycated hemoglobin
- HDL-C:
-
High-density lipoprotein cholesterol
- HOMA-IR:
-
Homeostatic model assessment of insulin resistance
- LAGB:
-
Laparoscopic-adjustable gastric banding
- LDL-C:
-
Low-density lipoprotein cholesterol
- Lp-PLA2 :
-
Lipoprotein-associated phospholipase A2
- LSG:
-
Laparoscopic sleeve gastrectomy
- MI:
-
Myocardial infarction
- PAI-1:
-
Plasminogen activator inhibitor-1
- RYGB:
-
Roux-en-Y gastric bypass
- SOS:
-
Swedish Obese Study
- TAG:
-
Triacylglycerol
- TC:
-
Total cholesterol
- T2D:
-
Type 2 diabetes mellitus
- TLR:
-
Toll-like receptor
References
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Kwok CS, Pradhan A, Khan MA, et al. Bariatric surgery and its impact on cardiovascular disease and mortality: a systematic review and meta-analysis. Int J Cardiol. 2014;173(1):20–8. This systematic review and meta-analysis summarizes the dramatic reduction of cardiovascular events in patients who had bariatric surgery in comparison to nonsurgical controls.
Heneghan HM, Nissen S, Schauer PR. Gastrointestinal surgery for obesity and diabetes: weight loss and control of hyperglycemia. Curr Atheroscler Rep. 2012;14(6):579–87.
Kral JG, Naslund E. Surgical treatment of obesity. Nat Clin Pract Endocrinol Metab. 2007;3(8):574–83.
Rubino F, Schauer PR, Kaplan LM, Cummings DE. Metabolic surgery to treat type 2 diabetes: clinical outcomes and mechanisms of action. Annu Rev Med. 2010;61:393–411.
Sjostrom L, Peltonen M, Jacobson P, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012;307(1):56–65.
Bigornia SJ, Farb MG, Tiwari S, et al. Insulin status and vascular responses to weight loss in obesity. J Am Coll Cardiol. 2013;62(24):2297–305.
Inaba S, Okayama H, Funada J, et al. Impact of type 2 diabetes on serial changes in tissue characteristics of coronary plaques: an integrated backscatter intravascular ultrasound analysis. Eur Heart J Cardiovasc Imaging. 2012;13(9):717–23.
Romeo S, Maglio C, Burza MA, et al. Cardiovascular events after bariatric surgery in obese subjects with type 2 diabetes. Diabetes Care. 2012;35(12):2613–7.
Tzoulaki I, Seretis A, Ntzani EE, Ioannidis JP. Mapping the expanded often inappropriate use of the Framingham Risk Score in the medical literature. J Clin Epidemiol. 2014;67(5):571–7.
Hemann BA, Bimson WF, Taylor AJ. The Framingham Risk Score: an appraisal of its benefits and limitations. Am Heart Hosp J. 2007;5(2):91–6.
Meikle PJ, Wong G, Tsorotes D, et al. Plasma lipidomic analysis of stable and unstable coronary artery disease. Arterioscler Thromb Vasc Biol. 2011;31(11):2723–32.
Chen SB, Lee YC, Ser KH, et al. Serum C-reactive protein and white blood cell count in morbidly obese surgical patients. Obes Surg. 2009;19(4):461–6.
Gumbau V, Bruna M, Canelles E, et al. A prospective study on inflammatory parameters in obese patients after sleeve gastrectomy. Obes Surg. 2014.
Habib P, Scrocco JD, Terek M, Vanek V, Mikolich JR. Effects of bariatric surgery on inflammatory, functional and structural markers of coronary atherosclerosis. Am J Cardiol. 2009;104(9):1251–5.
Hakeam HA, O’Regan PJ, Salem AM, Bamehriz FY, Jomaa LF. Inhibition of C-reactive protein in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2009;19(4):456–60.
Iannelli A, Anty R, Schneck AS, Tran A, Gugenheim J. Inflammation, insulin resistance, lipid disturbances, anthropometrics, and metabolic syndrome in morbidly obese patients: a case control study comparing laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy. Surgery. 2011;149(3):364–70.
Ruiz-Tovar J, Oller I, Galindo I, et al. Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg. 2013;23(6):764–9.
Wong AT, Chan DC, Armstrong J, Watts GF. Effect of laparoscopic sleeve gastrectomy on elevated C-reactive protein and atherogenic dyslipidemia in morbidly obese patients. Clin Biochem. 2011;44(4):342–4.
Woodard GA, Peraza J, Bravo S, Toplosky L, Hernandez-Boussard T, Morton JM. One year improvements in cardiovascular risk factors: a comparative trial of laparoscopic Roux-en-Y gastric bypass vs. adjustable gastric banding. Obes Surg. 2010;20(5):578–82.
Appachi S, Kashyap SR. ‘Adiposopathy’ and cardiovascular disease: the benefits of bariatric surgery. Curr Opin Cardiol. 2013;28(5):540–6.
Kardassis D, Schonander M, Sjostrom L, Karason K. Carotid artery remodelling in relation to body fat distribution, inflammation and sustained weight loss in obesity. J Intern Med. 2014;275(5):534–43.
Yao L, Herlea-Pana O, Heuser-Baker J, Chen Y, Barlic-Dicen J. Roles of the Chemokine system in development of obesity, insulin resistance, and cardiovascular disease. J Immunol Res. 2014;2014:181450.
de Jonge C, Rensen SS, Verdam FJ, et al. Endoscopic duodenal-jejunal bypass liner rapidly improves type 2 diabetes. Obes Surg. 2013;23(9):1354–60.
de Jonge C, Rensen SS, D’Agnolo HM, Bouvy ND, Buurman WA, Greve JW. Six months of treatment with the endoscopic duodenal-jejunal bypass liner does not lead to decreased systemic inflammation in obese patients with type 2 diabetes. Obes Surg. 2014;24(2):337–41.
Bays HE, Laferrere B, Dixon J, et al. Adiposopathy and bariatric surgery: is ‘sick fat’ a surgical disease? Int J Clin Pract. 2009;63(9):1285–300.
Bays H. Adiposopathy, “sick fat,” Ockham’s razor, and resolution of the obesity paradox. Curr Atheroscler Rep. 2014;16(5):409.
Li S, Shin HJ, Ding EL, van Dam RM. Adiponectin levels and risk of type 2 diabetes: a systematic review and meta-analysis. JAMA. 2009;302(2):179–88.
Sattar N, Nelson SM. Adiponectin, diabetes, and coronary heart disease in older persons: unraveling the paradox. J Clin Endocrinol Metab. 2008;93(9):3299–301.
Herder C, Peltonen M, Svensson PA, et al. Adiponectin and bariatric surgery: associations with diabetes and cardiovascular disease in the Swedish obese subjects study. Diabetes Care. 2014;37(5):1401–9.
Umemura A, Sasaki A, Nitta H, Otsuka K, Suto T, Wakabayashi G. Effects of changes in adipocyte hormones and visceral adipose tissue and the reduction of obesity-related comorbidities after laparoscopic sleeve gastrectomy in Japanese patients with severe obesity. Endocr J. 2014.
Brethauer SA, Heneghan HM, Eldar S, et al. Early effects of gastric bypass on endothelial function, inflammation, and cardiovascular risk in obese patients. Surg Endosc. 2011;25(8):2650–9.
Bradley D, Conte C, Mittendorfer B, et al. Gastric bypass and banding equally improve insulin sensitivity and beta cell function. J Clin Invest. 2012;122(12):4667–74.
Korner J, Inabnet W, Febres G, et al. Prospective study of gut hormone and metabolic changes after adjustable gastric banding and Roux-en-Y gastric bypass. Int J Obes (Lond). 2009;33(7):786–95.
Dickson SL, Egecioglu E, Landgren S, Skibicka KP, Engel JA, Jerlhag E. The role of the central ghrelin system in reward from food and chemical drugs. Mol Cell Endocrinol. 2011;340(1):80–7.
Pournaras DJ, Le Roux CW. The effect of bariatric surgery on gut hormones that alter appetite. Diabetes Metab. 2009;35(6 Pt 2):508–12.
Langer FB, Reza Hoda MA, Bohdjalian A, et al. Sleeve gastrectomy and gastric banding: effects on plasma ghrelin levels. Obes Surg. 2005;15(7):1024–9.
Murphy KG, Dhillo WS, Bloom SR. Gut peptides in the regulation of food intake and energy homeostasis. Endocr Rev. 2006;27(7):719–27.
Graessler J, Schwudke D, Schwarz PE, Herzog R, Shevchenko A, Bornstein SR. Top-down lipidomics reveals ether lipid deficiency in blood plasma of hypertensive patients. PLoS One. 2009;4(7):e6261.
Stegemann C, Drozdov I, Shalhoub J, et al. Comparative lipidomics profiling of human atherosclerotic plaques. Circ Cardiovasc Genet. 2011;4(3):232–42.
Stegemann C, Pechlaner R, Willeit P, et al. Lipidomics profiling and risk of cardiovascular disease in the prospective population-based Bruneck study. Circulation. 2014;129(18):1821–31. This prospective population-based study provides evidence showing individual lipid species outperform lipid families and classic risk factors with regard to CVD prediction on the basis of lipid network analysis.
Meikle PJ, Wong G, Barlow CK, et al. Plasma lipid profiling shows similar associations with prediabetes and type 2 diabetes. PLoS One. 2013;8(9):e74341. This study identified plasma lipidomic profile characterizing increased risk for type 2 diabetes mellitus in patients with prediabetes.
Sigruener A, Kleber ME, Heimerl S, Liebisch G, Schmitz G, Maerz W. Glycerophospholipid and sphingolipid species and mortality: the Ludwigshafen Risk and Cardiovascular Health (LURIC) study. PLoS One. 2014;9(1):e85724. This population-based study identified most deleterious and protective individual lipid species for use in risk prediction calculations.
Katz SS, Shipley GG, Small DM. Physical chemistry of the lipids of human atherosclerotic lesions. Demonstration of a lesion intermediate between fatty streaks and advanced plaques. J Clin Invest. 1976;58(1):200–11.
Schmitz G, Ruebsaamen K. Metabolism and atherogenic disease association of lysophosphatidylcholine. Atherosclerosis. 2010;208(1):10–8.
Kunnen S, Van Eck M. Lecithin:cholesterol acyltransferase: old friend or foe in atherosclerosis? J Lipid Res. 2012;53(9):1783–99.
Choi J, Zhang W, Gu X, et al. Lysophosphatidylcholine is generated by spontaneous deacylation of oxidized phospholipids. Chem Res Toxicol. 2011;24(1):111–8.
Goncalves I, Edsfeldt A, Ko NY, et al. Evidence supporting a key role of Lp-PLA2-generated lysophosphatidylcholine in human atherosclerotic plaque inflammation. Arterioscler Thromb Vasc Biol. 2012;32(6):1505–12.
Carneiro AB, Iaciura BM, Nohara LL, et al. Lysophosphatidylcholine triggers TLR2- and TLR4-mediated signaling pathways but counteracts LPS-induced NO synthesis in peritoneal macrophages by inhibiting NF-kappaB translocation and MAPK/ERK phosphorylation. PLoS One. 2013;8(9):e76233.
Erridge C. The roles of Toll-like receptors in atherosclerosis. J Innate Immun. 2009;1(4):340–9.
Huo T, Cai S, Lu X, Sha Y, Yu M, Li F. Metabonomic study of biochemical changes in the serum of type 2 diabetes mellitus patients after the treatment of metformin hydrochloride. J Pharm Biomed Anal. 2009;49(4):976–82.
Han MS, Lim YM, Quan W, et al. Lysophosphatidylcholine as an effector of fatty acid-induced insulin resistance. J Lipid Res. 2011;52(6):1234–46.
Yea K, Kim J, Yoon JH, et al. Lysophosphatidylcholine activates adipocyte glucose uptake and lowers blood glucose levels in murine models of diabetes. J Biol Chem. 2009;284(49):33833–40.
Graessler J, Bornstein TD, Goel D, et al. Lipidomic profiling before and after Roux-en-Y gastric bypass in obese patients with diabetes. Pharmacogenomics J. 2014;14(3):201–7.
Fernandez C, Sandin M, Sampaio JL, et al. Plasma lipid composition and risk of developing cardiovascular disease. PLoS One. 2013;8(8):e71846.
Spijkers LJ, van den Akker RF, Janssen BJ, et al. Hypertension is associated with marked alterations in sphingolipid biology: a potential role for ceramide. PLoS One. 2011;6(7):e21817.
Paumen MB, Ishida Y, Muramatsu M, Yamamoto M, Honjo T. Inhibition of carnitine palmitoyltransferase I augments sphingolipid synthesis and palmitate-induced apoptosis. J Biol Chem. 1997;272(6):3324–9.
Galadari S, Rahman A, Pallichankandy S, Galadari A, Thayyullathil F. Role of ceramide in diabetes mellitus: evidence and mechanisms. Lipids Health Dis. 2013;12:98.
Shimabukuro M, Zhou YT, Levi M, Unger RH. Fatty acid-induced beta cell apoptosis: a link between obesity and diabetes. Proc Natl Acad Sci U S A. 1998;95(5):2498–502.
Veret J, Coant N, Berdyshev EV, et al. Ceramide synthase 4 and de novo production of ceramides with specific N-acyl chain lengths are involved in glucolipotoxicity-induced apoptosis of INS-1 beta-cells. Biochem J. 2011;438(1):177–89.
Boslem E, Meikle PJ, Biden TJ. Roles of ceramide and sphingolipids in pancreatic beta-cell function and dysfunction. Islets. 2012;4(3):177–87.
Cunha DA, Hekerman P, Ladriere L, et al. Initiation and execution of lipotoxic ER stress in pancreatic beta-cells. J Cell Sci. 2008;121(Pt 14):2308–18.
Laybutt DR, Hawkins YC, Lock J, et al. Influence of diabetes on the loss of beta cell differentiation after islet transplantation in rats. Diabetologia. 2007;50(10):2117–25.
Karaskov E, Scott C, Zhang L, Teodoro T, Ravazzola M, Volchuk A. Chronic palmitate but not oleate exposure induces endoplasmic reticulum stress, which may contribute to INS-1 pancreatic beta-cell apoptosis. Endocrinology. 2006;147(7):3398–407.
Schmitz-Peiffer C, Craig DL, Biden TJ. Ceramide generation is sufficient to account for the inhibition of the insulin-stimulated PKB pathway in C2C12 skeletal muscle cells pretreated with palmitate. J Biol Chem. 1999;274(34):24202–10.
Chavez JA, Knotts TA, Wang LP, et al. A role for ceramide, but not diacylglycerol, in the antagonism of insulin signal transduction by saturated fatty acids. J Biol Chem. 2003;278(12):10297–303.
Mathis D, Vence L, Benoist C. beta-Cell death during progression to diabetes. Nature. 2001;414(6865):792–8.
Chandra J, Zhivotovsky B, Zaitsev S, Juntti-Berggren L, Berggren PO, Orrenius S. Role of apoptosis in pancreatic beta-cell death in diabetes. Diabetes. 2001;50 Suppl 1:S44–7.
Brozinick JT, Hawkins E, Hoang Bui H, et al. Plasma sphingolipids are biomarkers of metabolic syndrome in non-human primates maintained on a Western-style diet. Int J Obes (Lond). 2013;37(8):1064–70.
Adams 2nd JM, Pratipanawatr T, Berria R, et al. Ceramide content is increased in skeletal muscle from obese insulin-resistant humans. Diabetes. 2004;53(1):25–31.
Kelpe CL, Moore PC, Parazzoli SD, Wicksteed B, Rhodes CJ, Poitout V. Palmitate inhibition of insulin gene expression is mediated at the transcriptional level via ceramide synthesis. J Biol Chem. 2003;278(32):30015–21.
Chavez JA, Holland WL, Bar J, Sandhoff K, Summers SA. Acid ceramidase overexpression prevents the inhibitory effects of saturated fatty acids on insulin signaling. J Biol Chem. 2005;280(20):20148–53.
Chavez JA, Summers SA. A ceramide-centric view of insulin resistance. Cell Metab. 2012;15(5):585–94.
Tao C, Sifuentes A, Holland WL. Regulation of glucose and lipid homeostasis by adiponectin: effects on hepatocytes, pancreatic beta cells and adipocytes. Best Pract Res Clin Endocrinol Metab. 2014;28(1):43–58.
Shi H, Kokoeva MV, Inouye K, Tzameli I, Yin H, Flier JS. TLR4 links innate immunity and fatty acid-induced insulin resistance. J Clin Invest. 2006;116(11):3015–25.
Holland WL, Bikman BT, Wang LP, et al. Lipid-induced insulin resistance mediated by the proinflammatory receptor TLR4 requires saturated fatty acid-induced ceramide biosynthesis in mice. J Clin Invest. 2011;121(5):1858–70.
Caesar R, Fak F, Backhed F. Effects of gut microbiota on obesity and atherosclerosis via modulation of inflammation and lipid metabolism. J Intern Med. 2010;268(4):320–8.
Creely SJ, McTernan PG, Kusminski CM, et al. Lipopolysaccharide activates an innate immune system response in human adipose tissue in obesity and type 2 diabetes. Am J Physiol Endocrinol Metab. 2007;292(3):E740–7.
Funk JL, Feingold KR, Moser AH, Grunfeld C. Lipopolysaccharide stimulation of RAW 264.7 macrophages induces lipid accumulation and foam cell formation. Atherosclerosis. 1993;98(1):67–82.
Graessler J, Qin Y, Zhong H, et al. Metagenomic sequencing of the human gut microbiome before and after bariatric surgery in obese patients with type 2 diabetes: correlation with inflammatory and metabolic parameters. Pharmacogenomics J. 2013;13(6):514–22.
Karamanakos SN, Vagenas K, Kalfarentzos F, Alexandrides TK. Weight loss, appetite suppression, and changes in fasting and postprandial ghrelin and peptide-YY levels after Roux-en-Y gastric bypass and sleeve gastrectomy: a prospective, double blind study. Ann Surg. 2008;247(3):401–7.
To VT, Huttl TP, Lang R, Piotrowski K, Parhofer KG. Changes in body weight, glucose homeostasis, lipid profiles, and metabolic syndrome after restrictive bariatric surgery. Exp Clin Endocrinol Diabetes. 2012;120(9):547–52.
Heneghan HM, Huang H, Kashyap SR, et al. Reduced cardiovascular risk after bariatric surgery is linked to plasma ceramides, apolipoprotein-B100, and ApoB100/A1 ratio. Surg Obes Relat Dis. 2013;9(1):100–7.
Huang H, Kasumov T, Gatmaitan P, et al. Gastric bypass surgery reduces plasma ceramide subspecies and improves insulin sensitivity in severely obese patients. Obesity (Silver Spring). 2011;19(11):2235–40.
Viana EC, Araujo-Dasilio KL, Miguel GP, et al. Gastric bypass and sleeve gastrectomy: the same impact on IL-6 and TNF-alpha. Prospective clinical trial Obes Surg. 2013;23(8):1252–61.
Ali MR, Fuller WD, Rasmussen J. Detailed description of early response of metabolic syndrome after laparoscopic Roux-en-Y gastric bypass. Surg Obes Relat Dis. 2009;5(3):346–51.
Raffaelli M, Guidone C, Callari C, Iaconelli A, Bellantone R, Mingrone G. Effect of gastric bypass versus diet on cardiovascular risk factors. Ann Surg. 2014.
Shah SS, Todkar JS, Shah PS, Cummings DE. Diabetes remission and reduced cardiovascular risk after gastric bypass in Asian Indians with body mass index <35 kg/m(2). Surg Obes Relat Dis. 2010;6(4):332–8.
Dixon JB, O’Brien PE. Lipid profile in the severely obese: changes with weight loss after lap-band surgery. Obes Res. 2002;10(9):903–10.
Waldmann E, Huttl TP, Goke B, Lang R, Parhofer KG. Effect of sleeve gastrectomy on postprandial lipoprotein metabolism in morbidly obese patients. Lipids Health Dis. 2013;12:82.
Tsoli M, Chronaiou A, Kehagias I, Kalfarentzos F, Alexandrides TK. Hormone changes and diabetes resolution after biliopancreatic diversion and laparoscopic sleeve gastrectomy: a comparative prospective study. Surg Obes Relat Dis. 2013;9(5):667–77.
Bezante GP, Scopinaro A, Papadia F, et al. Biliopancreatic diversion reduces QT interval and dispersion in severely obese patients. Obesity (Silver Spring). 2007;15(6):1448–54.
Piche ME, Martin J, Cianflone K, et al. Changes in predicted cardiovascular disease risk after biliopancreatic diversion surgery in severely obese patients. Metabolism. 2014;63(1):79–86.
Vila M, Ruiz O, Belmonte M, et al. Changes in lipid profile and insulin resistance in obese patients after Scopinaro biliopancreatic diversion. Obes Surg. 2009;19(3):299–306.
Salani B, Briatore L, Andraghetti G, Adami GF, Maggi D, Cordera R. High-molecular weight adiponectin isoforms increase after biliopancreatic diversion in obese subjects. Obesity (Silver Spring). 2006;14(9):1511–4.
de Carvalho CP, Marin DM, de Souza AL, et al. GLP-1 and adiponectin: effect of weight loss after dietary restriction and gastric bypass in morbidly obese patients with normal and abnormal glucose metabolism. Obes Surg. 2009;19(3):313–20.
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Ryan H. Ban, Virginia Kamvissi, Klaus-Martin Schulte, Stefan Richard Bornstein, Francesco Rubino, and Juergen Graessler declare that they have no conflict of interest.
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This article is part of the Topical Collection on Lipid and Metabolic Effects of Gastrointestinal Surgery
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Ban, R.H., Kamvissi, V., Schulte, KM. et al. Lipidomic Profiling at the Interface of Metabolic Surgery and Cardiovascular Disease. Curr Atheroscler Rep 16, 455 (2014). https://doi.org/10.1007/s11883-014-0455-8
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DOI: https://doi.org/10.1007/s11883-014-0455-8